Much More Research Needed on Rare but Potentially Fatal Cardiovascular Disorder that Can Strike Healthy Pregnant Women

Yet There Has
Been Little Research to Address Peripartum Cardiomyopathy, as Reported in the Canadian
Journal of Cardiology

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Philadelphia, PA, July 15, 2015

Peripartum cardiomyopathy (PPCM)
is a rare disorder characterized by weakened pumping of the heart, or “left
ventricular dysfunction,” which results in otherwise healthy pregnant women
experiencing heart failure shortly before or up to five months after they
deliver healthy babies. Despite the seriousness of this condition, a new study
published in the Canadian Journal of Cardiology revealed that no
significant research has been undertaken to explore how to prevent or treat
this disorder. In fact, only three studies of possible treatments have ever
been conducted, and only two of those have shown any promise.

“Despite the serious illness and high risk of dying
attributed to PPCM in young, otherwise healthy women, the evidence guiding
clinicians in the treatment of this dramatic disease is scarce and of poor
quality,” explained lead investigator E. Marc Jolicoeur, MD, MSc, MHS,
Associate Clinical Professor and Director of Research, Adult Interventional
Cardiology Program, and first author Olivier Desplantie, MDCM, both of the
Montreal Heart Institute, University of Montreal.

PPCM affects from 1 to 5 women
per 10,000 live births. Despite current advances in heart failure treatment,
mortality related to PPCM at one and ten years can be as high as 4% and 7%,
respectively. These young, healthy women typically die from sudden cardiac
death or progressive heart failure with 18% of deaths occurring by the first
week and 87% by the sixth month after diagnosis. One in ten of these patients
will require heart transplantation.

Following a comprehensive search of the medical literature,
investigators identified two randomized controlled trials (RCT) that
investigated the effects of the hormone bromocriptine and the drug levosimendan
on PPCM, as well as a third, non-randomized prospective study of another drug,
pentoxifylline. In the bromocriptine study, 80% of the patients receiving the
drug experienced a significant reduction in adverse outcomes compared to10% of
the control patients. However, this study included only 20 South African
patients.

In the RCT of levosimendan, there were 24 patients enrolled.
There was no difference in all-cause mortality and no differences in any other
cardiac functional measurements between the therapy and control groups. In the
third study reviewed, after providing standard care to 29 patients with PPCM,
pentoxifylline was administered to 30 subsequent patients. Failure to improve
was found in 52% of the standard care group, while only 27% of the
pentoxifylline failed to improve.

For a disorder with such severe consequences, what can
explain the apparent lack of interest? In an editorial in the same issue,
Ricardo Cardona-Guarache, MD, MPH, and Jordana Kron, MD, of Virginia Commonwealth
University, Richmond, Virginia, suggest several reasons.

First, because the pathophysiology of PPCM is not well
understood, it is difficult to select potential therapies for trials. While
more common treatments for heart failure, such as beta-blockers and ACE
inhibitors, might be expected to help, results for women with PPCM have not
been favorable.

Further Cardona-Guarache and Kron noted that, “Historically,
exclusion of women from clinical trials was common practice, and the lack of
data on pregnant women and women of childbearing age can make informed
decision-making difficult for physicians and patients. Because PPCM occurs
exclusively in women of childbearing age, it is an extreme example that
highlights the systematic problem of gender bias in cardiovascular research.”
They added that women account for only 29% of patients in heart-failure trials
and 25% in coronary artery disease trails.

“PPCM needs further high quality investigation to guide
disease-specific therapy recommendations. We feel that the review by Jolicoeur
and his co-investigators should serve as a call to action for investigators to
renew efforts to further define the benefits of existing therapies and develop
novel therapies for PPCM,” stated Cardona-Guarache and Kron.

These articles appear online in advance of their issue in
the Canadian Journal of Cardiology, published by Elsevier.

Full text of these articles is available to credentialed
journalists upon request. Contact Eileen Leahy at +1 732-238-3628or cjcmedia@elsevier.com
to obtain copies. Journalists who wish to interview the study authors should
contact Lise Plante, Communications and Marketing Director, Montreal Heart
Institute Foundation, at +1 514-376-3330, extension 3898, or lise.plante@icm-mhi.org. Dr. Jordana Kron may be contacted
directly at +1 804-828-7571 (office), +1 352-359-6909 (cell), or jkron@mcvh-vcu.edu.

About the Canadian
Journal of CardiologyThe Canadian Journal of Cardiology is the official
journal of the Canadian Cardiovascular Society. It is a vehicle for the
international dissemination of new knowledge in cardiology and cardiovascular
science, particularly serving as a major venue for the results of Canadian
cardiovascular research and Society guidelines. The journal publishes original
reports of clinical and basic research relevant to cardiovascular medicine as
well as editorials, review articles, case reports, and papers on health
outcomes, policy research, ethics, medical history, and political issues
affecting practice. www.onlinecjc.ca

About the Editor-in-ChiefEditor-in-Chief Stanley Nattel, MD, is Paul-David Chair in
Cardiovascular Electrophysiology and Professor of Medicine at the University of
Montreal and Director of the Electrophysiology Research Program at the Montreal
Heart Institute Research Center.

About the Canadian
Cardiovascular SocietyThe Canadian Cardiovascular Society is the professional association
for Canadian cardiovascular physicians and scientists working to promote
cardiovascular health and care through knowledge translation, professional
development, and leadership in health policy. The CCS provides programs and
services to its 1900+ members and others in the cardiovascular community,
including guidelines for cardiovascular care, the annual Canadian
Cardiovascular Congress, and, with the Canadian Cardiovascular Academy,
programs for trainees. More information about the CCS and its activities can be
found at www.ccs.ca.

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